Retroperitoneal sarcomas: A review of disease spectrum,radiological features,characterisation and management

Retroperitoneal sarcomas are a rare disease. The overall 5‐year survival rate for these lesions remains low, and surgical management offers the only option for effective treatment and potential for cure. Radiotherapy is increasingly being employed in addition to standard surgical treatment. Improvements in cross‐sectional imaging have also facilitated better characterisation of lesions, preoperative planning and long‐term follow‐up. This article reviews the current literature and documents the various types of retroperitoneal sarcomas with a particular approach to their imaging features. We also highlight the pathology, diagnostic methods and most current management of these tumours.     

Joining the dots: a plea for precise estimates of the maternal mortality ratio in sub-Saharan Africa

Monitoring of maternal mortality levels in sub-Saharan Africa (SSA) to assess the achievements of safe motherhood programmes and for MDG-5 has been made difficult because of the lack of precise estimates of the maternal mortality ratio (MMR). Projections based on the slow rate of decline of the MMR indicate that MDG-5 may not be reached before the end of this century in this region. Measurements done using demographical and health surveys, statistical modelling and censuses are imprecise and do not allow trends in individual countries to be established. SSA countries should be encouraged to measure mortality levels from their own resources, using methods that produce precise estimates such as population-based surveys. Establishment of the trends will lead to country-specific program targets. The less frequent but more precise measurements can be afforded by SSA countries, as a case study from Zimbabwe shows.     

Accuracy of fetal echocardiography

The reliability of prenatal ultrasound (US) for the detection of structural heart defects was investigated in a consecutive population of patients referred for prenatal US. Twenty-eight of 49 fetuses (57%) shown to have one or more heart defects with physical examination or autopsy were found to have congenital heart disease with prenatal US. There were 66 cardiac defects in 49 fetuses, 33 of which were entirely or partly identified (50%). Defects correctly diagnosed included hypoplasia of either ventricle, common atrioventricular canal, tetralogy of Fallot, transposition of the great vessels, and Ebstein anomaly. Defects rarely diagnosed correctly included semilunar valve stenosis, total anomalous pulmonary venous drainage, coarctation of the aorta, pulmonic atresia, atrioseptal defect, and ventricular septal defect. Many types of heart defects can be diagnosed accurately with prenatal US in a general population of patients not at high risk for congenital heart disease. Some lesions, however, were difficult to detect.     

Anti-Inflammatory Activity in the Low Molecular Weight Fraction of Commercial Human Serum Albumin (LMWF5A)

The innate immune system is increasingly being recognized as a critical component in osteoarthritis (OA) pathophysiology. An ex vivo immunoassay utilizing human peripheral blood mononuclear cells (PBMC) was developed in order to assess the OA anti-inflammatory properties of the low molecular weight fraction (<5 kDa) of commercial human serum albumin (LMWF5A). PBMC from various donors were pre-incubated with LMWF5A before LPS stimulation. TNFα release was measured by ELISA in supernatants after an overnight incubation. A ≥ 30% decrease in TNFα release was observed. This anti-inflammatory effect is potentially useful in assessing potency of LMWF5A for the treatment of OA.     

Youth Exposed to Terrorism: the Moderating Role of Ideology

The present review examines the moderating role of ideology on the effects of war, armed conflict, and terrorism on youth. Ideology is an important factor given the central role played by religio-political ideology and nationalism in present-day conflicts. Ideologies or worldviews represent cognitive frameworks that imbue the traumatic situation with meaning and order. Analysis of the pool of studies identified three categories of ideologically based moderating factors, each representing an aspect of social construction of traumatic events, namely, religion, political ideology, and self-concept. The two closely related categories of religion and politico-religious beliefs showed both positive and negative effects on psychological and psychiatric outcomes among youth. The third category of different aspects of self-concept yielded consistently positive moderating effects. The mechanisms by which each category of ideology moderates effects of exposure to war, armed conflict, and terrorism are discussed, and research and clinical implications are presented.     

The effect of botulinum toxin type A injections on the natural history of equinus foot deformity in paediatric cerebral palsy patients

Neuromuscular blockade with botulinum toxin type A (BTX-A) injections was employed to manage equinus foot deformity in the lower extremities of paediatric cerebral palsy patients. The patients were followed to evaluate the effect of the blockade on lower extremity function and to determine the effect of treatment on the need for tendo-Achilles lengthening (TAL) surgery. The average length of follow-up was 3.4 years. Of the 48 patients, 17 (35%) responded to treatment witbin 6 months of initiation of therapy, as determined by a Physician Rating Scale of gait. Overall, 25 (52%) of the 48 patients underwent TAL surgery during the follow-up period, including eight patients who responded to the BTX-A treatment. The average age of the patients at the time of surgery was 7 years. This age compares favourably with the age at surgery reported in the recent literature. There were no significant differences by responder status, age, or gender in those patients who did and did not require TAL surgery. No adverse events relating to BTX-A were reported. These results indicate that patients who respond to BTX-A treatment have improved physical functioning and gait, and are able to sustain these results long term.